POS0570 IMPACT OF CLINICIAN-RELATED FACTORS ON PHONE CONSULTATIONS IN RHEUMATOLOGY – ANALYSIS OF MEDICAL VS NON-MEDICAL CLINICIANS’ OUTCOMES FROM A COVID-19 INITIATIVE
Authors: M. Hannides, S. Wig, S. Vasireddy
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Since COVID-19 pandemic, there have been changes in clinical practice to limit transmission, such as switching to remote consultations. Our department switched to delivering remote consultations during lockdown without suspending service. Patients were offered choice of either video or phone consultation. It is unclear if the medical vs non-medical status of clinicians has any influence on remote consultations. <h3>Objectives</h3> We aimed to study the influence of medical vs non-medical status of clinicians on phone consultations in our experience during the pandemic. <h3>Methods</h3> Between 15/10/2020 and 09/11/2020, 12 clinicians in our service completed data collection forms after each remote consultation, recording the technology used (video vs phone); technical problems encountered; discharge and subsequent appointment status; and technical aspects of the consultation itself using 11-point numerical rating scales (NRS) (Time Adequate; Relevant History; Physical Exam; Management Plan; and Communication Quality). Data were analysed in SPSS version 25 using chi-square tests and Mann-Whitney U tests for comparisons.. <h3>Results</h3> Six medical clinicians (3 consultant rheumatologists, 2 Specialty Trainee Registrars and 1 Foundation Year 2 doctor) and six non-medical clinicians (3 Specialist Nurses, 1 Advanced Rheumatology Practitioner and 2 Senior Rheumatology Pharmacists) completed 285 forms. As non-medical clinicians didn't do new patient consultations, and as some clinicians did not do video consultations, these consultations were excluded. The remaining were follow-up patient phone consultations (n=196). Medical vs non-medical clinician appointments were 34.7% (n= 68), vs 65.3% (n=128). Medical and non-medical clinicians had a similar proportion of female patients (72.1%, n=49 vs 63.3%, n=81; p=0.22); similar mean age of their patients (63 vs 62 years; p=0.53); similar rates of technical problems reported (13.1%, n=8 vs 16.4%, n=19; p=0.57); and similar rates of interpreter use (3%, n=2 vs 3.5%, n=4; p=0.86). Medical clinicians had lower mean scores compared to the non-medical clinicians on NRS for Time Adequate (8.37 vs 8.57; p=0.013); Relevant History (8.55 vs 9.02; p&lt;0.001); Management Plan (6.91 vs 8.17; p&lt;0.001); and Communication Quality (7.85 vs 8.81, p&lt;0.001); and had no significant difference in scores for Physical Exam (0.63 vs 1.75; p=0.19). Medical clinicians had a non-significant trend for higher rate of subsequent face-to-face appointments (21.9%, n=11 vs 11.6%, n=14; p=0.10); and a higher rate of discharge outcome compared with non-medical clinicians (23.5%, n=16 vs 1.6% n=2; p&lt;0.001). <h3>Conclusion</h3> There were no significant differences between medical and non-medical clinicians in distributions of patients' gender or age, and rates of technical problems and interpreter use. While there was a non-significant trend for lower scores on Physical Exam NRS for medical clinicians, both mean scores were low reflecting the difficulty of this assessment in a phone consultation. Medical clinicians rated their consultations significantly lower in four of the NRS, potentially reflecting the complexity of medical problems of patients booked into medical clinicians' clinics compared to potentially patients with more stable disease in non-medical clinicians' clinics. Similarly, the lower discharge rate from non-medical clinicians' clinics could reflect a higher proportion of patients on established disease needing long-term follow-up. Further studies with larger numbers would help clarify these issues. <h3>Acknowledgements</h3> We thank the following clinicians who completed the data collection forms in clinic, in addition to the authors: L Bromilow, J Haworth, J Lane, S Ling, A Paul, C Potts, W Ramli, A Robinson, R Wray. <h3>Disclosure of Interests</h3> None Declared.